New Attending

Well into my first month as an attending in general medicine at an academic medical center, I admit I am completely overwhelmed. I thought I could handle this whole outpatient clinic gig. Preventative care of outpatients was what I was trained to do in residency. Calcium with vitamin D, breast exams, colonoscopy referrals, vaccines. But now that I've gone and started the practice of medicine in the form of crazy full-time outpatient clinic immersion, I feel like I'm digging out of a freshly-dug grave every day and my fingernails can't quite get clean or get a good grip.

It's only that bad sometimes. Other times, I think I know what I'm doing, but there's no one else above me anymore to check that. We have an electronic medical record, which is great for legibility and communication, though challenging for my carpal tunnels.

Last week, I had a new patient visit, 79 yr old monk with multiple medical issues, transfer of care from his long-time physician for reasons unclear to me. He arrived with his monsignor and 300 pages worth of medical records for me to read, know, and act upon. His new patient visit. was somehow scheduled, likely by accident, for a 10-MINUTE VISIT. He will make another appointment to complete the new patient visit, which was no problem, the monastery is flexible. But my god. I read through the patient chart after hours and typed in his history into the EMR and actually REACHED MY CHARACTER LIMIT. The computer would not allow me to type in any more characters. It was possible. I'd hit some alternative dimension.

I had to open a new chart for him in the end.

Having that large stack of medical records in front of me, newly charged with responsibility for this patient as his new primary care physician, I felt like I was back in medical school and perhaps even organic chemistry class again. All that memorization, pages and pages of text. The fact that I could read that much information and try to remember some of it in my 20's helped me forge ahead with the textbook of a real person in my 30's.

I'm still overwhelmed. It doesn't help to know that hardly any U.S. medical student dreams of doing what I'm doing-- primary care medicine-- when they finish residency. I don't blame them. My medical school loans are heavy, but not even half as heavy as average med school loan debt today, mostly because I attended a public university for medical school and paid in-state tuition. I was lucky to have that option.

I shouldn't really complain. But that's what this blog is for! Constructive complaining, at least. I'm still optimistic the road to primary care private practice gets easier. It has to.